Provider Demographics
NPI:1639200215
Name:RYAN K ANDERSON D P M P C.
Entity Type:Organization
Organization Name:RYAN K ANDERSON D P M P C.
Other - Org Name:FOOT & ANKLE SPECIALISTS OF UTAH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:801-292-4425
Mailing Address - Street 1:PO BOX 1249
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84011-1249
Mailing Address - Country:US
Mailing Address - Phone:801-296-2113
Mailing Address - Fax:801-296-1715
Practice Address - Street 1:596 W 750 S
Practice Address - Street 2:SUITE 200
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-7268
Practice Address - Country:US
Practice Address - Phone:801-292-4425
Practice Address - Fax:801-397-1938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT74619OtherPEHP
UT529471093001Medicaid
UTU91268Medicare UPIN
UT005738401Medicare ID - Type Unspecified
UTDA6545Medicare PIN
UT000057384Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
UT529471093001Medicaid